74BAI-S2953 LOSS_RUN -redacted.xlsx
XLSX spreadsheet 241 KB Posted
- Solicitation number
- 74BAI-S2953
- Issued by
- Nevada
About this file
The document outlines a state and local contract opportunity for Workers Compensation Uninsured Claims Administration issued by the State of Nevada, Department of Business and Industry (DIR), Workers' Compensation Section (WCS). The selected third-party administrator (TPA) will be responsible for investigating, administering, and managing all claims for the Uninsured Employers' Claim Account (UECA), including claims handling, case management, litigation support, and reporting. The initial contract term is four years, anticipated to begin upon Board of Examiners approval and terminate on December 31, 2028. Proposals are due by October 17, 2024 at 2:00 pm Pacific Time, with a notice of award estimated on or about November 19, 2024.
The procurement does not specify any set-aside designations or restrictions on the types of organizations that can respond. The RFP does not identify any incumbent vendors or current contractors, nor does it provide information on any existing infrastructure or technology that requires integration. The RFP document does not disclose the anticipated award value or budget range for this contract opportunity.
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Other files
| File | Type | Posted |
|---|---|---|
| Quote Instructions.pdf | ||
| 74BAI-S2953 RFP - Revised Workers Compensation Uninsured Claims Administration.docx | DOCX document | |
| 74BAI-S2953 Cost Schedule.docx | DOCX document | |
| 74BAI-S2953 Insurance Schedule.docx | DOCX document | |
| 74BAI-S2953 RFP Workers Comp Uninsured Claims Administration.docx | DOCX document | |
| Terms and Conditions for Services~4.pdf | ||
| 74BAI-S2953 Letter of Intent.docx | DOCX document | |
| Attachments for Signature~3.pdf | ||
| Proposed Staff Resume~2.docx | DOCX document | |
| Multiple Files to Reference Q and A.pdf | ||
| 74BAI-S2953 Scope of Work.docx | DOCX document | |
| Reference Questionnaire.docx | DOCX document | |
| Standard Form Contract~9.docx | DOCX document | |
| Terms and Conditions for Goods 2023-04-14.pdf | ||
| 74BAI-S2953 Q and A - 10.8.24.xls | XLS spreadsheet |
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| Company | Claim No | Loss Date | Claim Status | Loss Descr | Loss Cause Descr | Med Paid Period | Med Paid To Date | Med Incurred | Ind Paid Period | Ind Paid To Date | Ind Incurred | Rhb Paid To Date | Rhb Incurred | Oth Paid Period | Oth Incurred | Tot Paid | Tot Incr | Tot Rsv | |
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 077050000062 | 9/20/2004 | O | IW was lifting plyboard and injured lower back. **QUARTERLY VISITS, RXS ONLY.** | Strain; lifting | $119,807.79 | $119,807.79 | $212,934.88 | $73,428.72 | $73,428.72 | $73,428.72 | $930.00 | $3,000.00 | $22,388.10 | $24,146.21 | $216,554.61 | $313,509.81 | $96,955.20 | |
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 127050000038 | 8/2/2011 | P | IW was lowering a car down, a frame machine and it slammed down crushing his left hand and amputating left index finger. **PAYING MONTHLY PPD INSTALLMENTS TO 12/11/2027 ONLY** | Caught; in, under, between, | $19,148.91 | $19,148.91 | $19,148.91 | $75,679.83 | $75,679.83 | $80,609.40 | $2,289.92 | $2,289.92 | $8.25 | $8.25 | $97,126.91 | $102,056.48 | $4,929.57 | |
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 127050000221 | 3/6/2012 | O | On 03/06/2012 iw was sweeping trash on 1st floor of building (with shovel), had debris go in R eye lacerating it. **OVS & EYE DROPS ONLY** | Misc; foreign matter (body) in eye(s) | $19,118.50 | $19,118.50 | $38,163.10 | $17,116.42 | $17,116.42 | $17,116.42 | $0.00 | $0.00 | $1,101.08 | $1,158.90 | $37,336.00 | $56,438.42 | $19,102.42 | |
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 147050000180 | 6/30/2014 | O | IW WAS SETTING CONCRETE WALL AND THE BACKHOE BUCKE PINCHED HIS RIGHT ARM AGAINST THE CONCRETE WALL | |||||||||||||||
| RN assigned 02/05/18 - MM | Caught; in, under, between, | $77,220.98 | $77,220.98 | $77,220.98 | $184,437.29 | $184,437.29 | $187,078.49 | $34,732.91 | $34,732.91 | $6,928.59 | $10,250.00 | $303,319.77 | $309,282.38 | $5,962.61 | |||||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 167050000029 | 8/8/2016 | O | WALKED TO FRIDGE TO PUT LUNCH IN AND SLIPPED ON WATER DUE TO WATER LEAK IN SINK. HIT HEAD. | Fall; from liquid or grease spills | $39,025.78 | $39,025.78 | $70,310.00 | $11,417.76 | $11,417.76 | $63,069.39 | $3,689.61 | $6,060.00 | $54,133.15 | $139,439.39 | $85,306.24 | |||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 177050000005 | 9/4/2014 | O | FELL 20 FT WHEN PART OF RIGGING FELL WHILE BEING DISASSEMBLED. IW at fault due to his miss-use of safety harness. | Fall; from different level/elevation | $323,648.25 | $321,623.98 | $916,899.09 | $315,652.75 | $315,652.75 | $1,564,585.37 | $73,221.51 | $73,221.51 | $11,543.40 | $18,217.50 | $722,041.64 | $2,572,923.47 | $1,850,881.83 | |
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 190485UEF | 9/17/2001 | O | Emergency ph # 775-782-5363 Alicia Rubio (cousin.) **PPD MONTHLY INSTALLMENTS UP TO 9/19/2045** | Misc; other - miscellaneous, | $137,881.49 | $137,881.49 | $137,881.49 | $126,619.10 | $126,619.10 | $163,630.47 | $2,283.53 | $2,283.53 | $4,409.58 | $4,409.58 | $271,193.70 | $308,205.07 | $37,011.37 | |
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 197050000003 | 10/21/2017 | O | HE WAS LOOKING THROUGH A PLASTIC TANK, CHECKING TEST RESULTS WHEN THE TANK EXPLODED CAUSING SEVERE BURNS/FACIAL FRACTURES/LOSS OF SIGHT LEFT EYE | Burn; Chemicals | $59,978.42 | $59,978.42 | $99,000.00 | $55,849.42 | $55,849.42 | $106,795.93 | $1,900.50 | $5,500.00 | $117,728.34 | $211,295.93 | $93,567.59 | |||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 197050000008 | 2/16/2019 | O | VIOLENT ATTACK BY UNKNOWN PERSON | Injured by; Another Person | $76,996.85 | $76,996.85 | $83,048.00 | $42,590.25 | $42,590.25 | $46,169.60 | $14,774.53 | $22,255.00 | $134,361.63 | $151,472.60 | $17,110.97 | |||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 207050000013 | 6/2/2018 | O | EE WAS DRYING THE DOG OFF WHEN SHE GOT BIT IN THE FACE. | Strain; Hanging | $5,818.91 | $5,818.91 | $5,818.91 | $3,969.92 | $3,969.92 | $3,969.92 | $925.22 | $925.22 | $10,714.05 | $10,714.05 | $0.00 | |||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 207050000017 | 3/20/2019 | O | EE WAS LIFTING CONCRETE AND DEMO HEAVY MATERIALS | Strain; twisting | $17,565.61 | $17,565.61 | $26,162.19 | $26,705.22 | $26,705.22 | $61,682.42 | $2,538.74 | $2,738.74 | $46,809.57 | $90,583.35 | $43,773.78 | |||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 207050000020 | 7/9/2019 | O | EE WAS INVOLVED IN A CAR ACCIDENT | Injured by; object being lifted/handled | $93,643.46 | $90,734.82 | $128,294.00 | $32,024.01 | $32,024.01 | $98,574.04 | $273.84 | $18,239.68 | $22,719.27 | $25,803.80 | $145,751.94 | $270,911.52 | $125,159.58 | |
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 207050000030 | 1/15/2020 | R | EE WAS DOING REPAIRS ON A VEHICLE IN A LIFT WHEN HE SLIPPED OFF THE STEP STOOL | Strain; walking | $8,833.59 | $8,833.59 | $12,051.41 | $12,470.37 | $12,470.37 | $14,095.21 | $9,402.21 | $11,862.75 | $30,706.17 | $38,009.37 | $7,303.20 | |||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 217050000043 | 12/21/2020 | O | EE WAS DRIVING DOWN HILL WHEN THE BRAKES ON HIS TRUCK STOPPED WORKING. | Vehicle; motor vehicle | $16,732.30 | $16,732.30 | $18,200.00 | $2,138.34 | $2,138.34 | $18,870.64 | $20,338.34 | $1,467.70 | ||||||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 217050000050 | 4/20/2021 | R | A CHAIR FELL DOWN AND FELL ON HIS NOSE. | Injured by; falling or flying object | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||||||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 227050000001 | 7/21/2021 | O | FELL OFF STEP STOOL CLEANING SHOWER WALL | Fall, slip or trip, | $4,473.33 | $4,473.33 | $5,000.00 | $104.00 | $104.00 | $4,577.33 | $5,104.00 | $526.67 | ||||||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 227050000002 | 10/27/2021 | O | CUTTING DOOR WITH HAND SAW, SAW GOT STUCK ON DOOR AND CUTTING LEFT HAND | Injured by; hand tool or machine in use | $31,285.95 | $31,285.95 | $34,220.00 | $71,673.51 | $71,673.51 | $76,135.32 | $9,645.70 | $60,000.00 | $112,605.16 | $170,355.32 | $57,750.16 | |||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 227050000007 | 11/17/2021 | O | STEPPING OUT OF TRUCK. REINJURED LEFT ANKLE. | Strain; strain or injury by, | $18,168.01 | $16,759.25 | $23,350.00 | $52,193.85 | $52,193.85 | $72,788.16 | $1,493.38 | $60,000.00 | $0.00 | $12.75 | $70,446.48 | $156,150.91 | $85,704.43 | |
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 227050000010 | 4/7/2022 | O | MOTOR VEHICLE ACCIDENT. | Vehicle; collide with other vehicle | $33,883.68 | $33,878.93 | $51,920.00 | $29,562.01 | $29,562.01 | $50,716.54 | $63,440.94 | $102,636.54 | $39,195.60 | |||||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 227050000011 | 3/16/2022 | O | DRIVING FROM CLIENT HOUSE TO NEXT CLIENT HOUSE HAD CAR ACCIDENT | Injured by; motor vehicle | $7,957.75 | $7,957.75 | $10,000.00 | $0.00 | $0.00 | $9,500.00 | $167.66 | $500.00 | $8,125.41 | $20,000.00 | $11,874.59 | |||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 227050000015 | 4/15/2022 | O | ADJUSTED PATIENT THEN HAD PAIN IN HER RIGHT SHOULDER | Strain; strain or injury by, | $3,921.68 | $3,432.94 | $8,500.00 | $2,882.87 | $2,882.87 | $24,000.00 | $0.00 | $500.00 | $6,315.81 | $33,000.00 | $26,684.19 | |||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 237050000001 | 10/24/2022 | O | FOOT WAS RAN OVER AND THE FORKLIFT ON TOP OF HIS FOOT. | Caught; in, under, between, | $4,514.50 | $4,514.50 | $10,000.00 | $32.00 | $500.00 | $4,546.50 | $10,500.00 | $5,953.50 | ||||||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 237050000005 | 11/29/2022 | O | WORKING ON THE ROOF AND FELL THROUGH THE ROOF. | Fall; from different level/elevation | $12,424.99 | $12,424.99 | $15,000.00 | $0.00 | $0.00 | $20,000.00 | $0.00 | $0.00 | $12,424.99 | $35,000.00 | $22,575.01 | |||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 237050000006 | 1/27/2023 | O | CONNECTING A GENERATOR. | Unknown | $4,743.58 | $4,743.58 | $8,200.00 | $4,743.58 | $8,200.00 | $3,456.42 | ||||||||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 237050000007 | 7/10/2023 | O | TRUCK ROLLOVER ACCIDENT DUE TO IMPROPER TRAILER LOAD. | Caught; in, under, between, | $37,719.04 | $37,591.09 | $57,600.00 | $52,838.82 | $52,838.82 | $118,125.80 | $90,429.91 | $175,725.80 | $85,295.89 | |||||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 237050000008 | 2/26/2023 | O | MOTOR VEHICLE ACCIDENT | Injured by; motor vehicle | $4,425.40 | $1,127.57 | $6,000.00 | $181.80 | $181.80 | $1,309.37 | $6,181.80 | $4,872.43 | ||||||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 237050000010 | 5/4/2023 | O | CARRYING A TRAY OF WATER, SLIPPED AND FELL DOWN STAIRS | Fall, slip or trip, | $3,322.59 | $3,322.59 | $5,000.00 | $6,319.47 | $6,319.47 | $13,000.00 | $0.00 | $33.00 | $9,642.06 | $18,033.00 | $8,390.94 | |||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 237050000011 | 3/23/2023 | O | REAR-ENDED BY A PASSENGER BUS. | Vehicle; collide with other vehicle | $15,853.57 | $15,853.57 | $20,000.00 | $18,775.76 | $7,438.76 | $22,223.00 | $239.96 | $40,000.00 | $23,532.29 | $82,223.00 | $58,690.71 | |||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 237050000012 | 9/20/2023 | O | MVA - DRIVING WHEN BRAKES WENT OUT | Vehicle; collide with other vehicle | $4,112.60 | $4,112.60 | $6,000.00 | $45,107.92 | $45,107.92 | $53,000.00 | $49,220.52 | $59,000.00 | $9,779.48 | |||||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 247050000001 | 3/6/2022 | O | MVA. CAR FLIPPED. | Vehicle; collide with other vehicle | $2,924.27 | $2,761.79 | $8,000.00 | $80.00 | $80.00 | $2,841.79 | $8,080.00 | $5,238.21 | ||||||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 247050000002 | 7/18/2022 | O | MOTOR VEHICLE ACCIDENT. | Vehicle; motor vehicle | $2,235.20 | $819.59 | $18,000.00 | $1,714.50 | $1,714.50 | $28,267.20 | $2,534.09 | $46,267.20 | $43,733.11 | |||||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 247050000003 | 1/5/2024 | O | HE WAS DRIVING DOWN THE ROAD AT AROUND 35MPH WHEN HIS TRUCK AND TRAILER SUDDENLY BEGAN TO SLIDE CAUSING THE VEHICLE TO ROLL ONTO ITS RIGHT SIDE CAUSING HIM TO FALL FROM THE DRIVER'S SEAT ONTO THE OTHER SIDE OF THE CABIN. | Injured by; motor vehicle | $2,100.00 | $2,100.00 | $20,000.00 | $2,100.00 | $20,000.00 | $17,900.00 | ||||||||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 247050000004 | 3/11/2024 | O | HIGH TENSION ROPE FROM A TREE THAT WAS BEING REMOVED SNAPPED AND HIT THE RIGHT SIDE OF FACE | Injured by; falling or flying object | $0.00 | $0.00 | $50,000.00 | $0.00 | $50,000.00 | $50,000.00 | ||||||||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 810168814UEF | 1/27/1981 | O | HEAD INJURY, DEATH CLAIM. **WIDOW/BENEFICIARY BENEFITS - JOYCE NEWTON** | Misc; person in act of crime | $30,799.89 | $30,799.89 | $30,799.89 | $248,347.30 | $248,347.30 | $342,665.55 | $279,147.19 | $373,465.44 | $94,318.25 | |||||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 830227787UEF | 6/21/1983 | O | Amputation. **PPD ANNUAL INSTALLMENTS UP TO 04/25/2031** | Caught; in, under, between, | $22,302.00 | $22,302.00 | $28,546.56 | $22,302.00 | $28,546.56 | $6,244.56 | ||||||||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 860690102UEF | 1/1/1986 | O | Injured lower back | Injured by; moving parts of machine | $37,740.86 | $37,740.86 | $74,318.10 | $318,384.76 | $318,384.76 | $365,524.80 | $4,615.49 | $19,662.42 | $360,741.11 | $459,505.32 | $98,764.21 | |||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 880913150UEF | 6/27/1988 | R | Amputation. **ANNUAL PPD INSTALLMENTS UNTIL 2/13/2037** | Caught; in, under, between, | $5,618.96 | $5,618.96 | $8,268.00 | $444.00 | $620.63 | $6,062.96 | $8,888.63 | $2,825.67 | ||||||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 890673873UEF | 11/11/1988 | O | fall | Passed Out | $21,586.44 | $21,586.44 | $57,500.00 | $399,195.12 | $399,195.12 | $463,337.55 | $1,957.22 | $3,800.00 | $422,738.78 | $524,637.55 | $101,898.77 | |||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 900735816UEF | 10/15/1989 | O | **MONTHLY PPD INSTALLMENTS TO 10/14/2035** | Caught; in, under, between, | $33,250.04 | $33,250.04 | $47,028.31 | $642.00 | $1,000.00 | $33,892.04 | $48,028.31 | $14,136.27 | ||||||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 910971060UEF | 5/26/1991 | O | **PPD MONTHLY INSTALLMENTS UNTIL 4/22/2029** | Burn; fire or flame | $0.00 | $0.00 | $0.00 | $67,644.82 | $67,644.82 | $77,871.30 | $0.00 | $0.00 | $4.75 | $9.50 | $67,649.57 | $77,880.80 | $10,231.23 | |
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 920724285UE | 12/22/1991 | O | GUN SHOT WOUND TO BRAIN IW'S HOME PHONE NUMBER: 702-773-5302 | Misc; person in act of crime | $1,047,843.24 | $1,047,843.24 | $1,299,462.66 | $136,854.06 | $136,854.06 | $174,871.45 | $350.00 | $350.00 | $3,758.34 | $13,066.67 | $1,188,805.64 | $1,487,750.78 | $298,945.14 | |
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 930794094UEF | 2/16/1993 | O | MVA multiple injuries. 26%PPD. **PPD ANNUAL INSTALLMENTS UNTIL 3/30/2034** | Misc; other - miscellaneous, | $4,577.76 | $4,577.76 | $5,894.88 | $4,577.76 | $5,894.88 | $1,317.12 | ||||||||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 970379193UEF | 2/27/1997 | O | Death. **WIDOW/BENEFICIARY BENEFITS - ANNA HOLLAND** | Passed Out | $23,093.44 | $23,093.44 | $23,093.44 | $190,387.60 | $190,387.60 | $457,074.04 | $213,481.04 | $480,167.48 | $266,686.44 | |||||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 980346970UEF | 12/2/1997 | O | POST OP X 4 FUSIONS TO LUMBAR SPINE. **PTD, OFFICE VISITS, RXS, IN ARIZONA** | Injured by; object being lifted/handled | $479,189.34 | $479,189.34 | $504,286.54 | $653,241.00 | $653,241.00 | $834,647.70 | $5,388.64 | $5,388.64 | $14,063.25 | $20,652.02 | $1,151,882.23 | $1,364,974.90 | $213,092.67 | |
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | UE01-90388 | 9/17/2001 | O | **PPD MONTHLY INSTALLMENTS UNTIL 8/9/2043.** | Injured by; explosion or flare back | $303,212.19 | $303,212.19 | $303,212.19 | $196,593.46 | $196,593.46 | $303,712.24 | $701.93 | $701.93 | $5,982.02 | $5,982.02 | $506,489.60 | $613,608.38 | $107,118.78 | |
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | UE03-00022 | 7/29/2003 | O | A 10-12LB TARP APPARATIS CAME LOOSE FELL 10 FEET HIT EMPLOYEE IN HEAD. | Injured by; falling or flying object | $43,553.69 | $43,553.69 | $43,553.69 | $566,007.56 | $564,792.68 | $1,115,236.51 | $17,344.77 | $17,344.77 | $12,678.33 | $12,678.33 | $638,369.47 | $1,188,813.30 | $550,443.83 | |
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | UE05-00014 | 1/30/2005 | O | Moving office furniture. **ANNUAL PPD INSTALLMENTS TO 11/23/2037** | Injured by; moving parts of machine | $82,810.32 | $82,810.32 | $82,810.32 | $73,994.08 | $73,994.08 | $78,085.55 | $1,918.56 | $1,918.56 | $158,722.96 | $162,814.43 | $4,091.47 | |||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | UE06-00002 | 12/12/2005 | R | Driving a truck.While driving a truck Mr. Posada lost control of the truck and it rolled over. Diagnosis; multiple fractures to the legs/arms. **ANNUAL PPD INSTALLMENTS UNTIL 6/5/2042.** | Vehicle; motor vehicle | $85,812.30 | $85,812.30 | $85,812.30 | $160,420.92 | $160,420.92 | $176,213.88 | $3,559.92 | $3,559.92 | $1,611.14 | $1,611.14 | $251,404.28 | $267,197.24 | $15,792.96 | |
| Count: 48 | $3,365,128.69 | $3,353,289.66 | $4,706,772.09 | $4,335,849.21 | $4,323,297.33 | $7,447,539.72 | $152,456.01 | $321,112.81 | $152,707.98 | $218,387.13 | $7,981,750.98 | $12,693,811.75 | $4,712,060.77 |
CLOSED
| Company | Claim No | Loss Date | Claim Status | Loss Descr | Loss Cause Descr | Med Paid Period | Med Paid To Date | Med Incurred | Ind Paid Period | Ind Paid To Date | Ind Incurred | Rhb Paid To Date | Rhb Incurred | Oth Paid Period | Oth Incurred | Tot Paid | Tot Incr | Tot Rsv |
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 000103135UEF | 8/4/1999 | C | Misc; other - miscellaneous, | $826.86 | $826.86 | $826.86 | $826.86 | $826.86 | $0.00 | ||||||||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 077050000061 | 5/24/2007 | C | IW WAS BATHING CAT AND WAS BITTEN |
| LEFT 2ND FINGER CAT BITE | Injured by; animal or insect | $64.15 | $64.15 | $64.15 | $0.00 | $0.00 | $64.15 | $64.15 | $0.00 | |
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 077050000063 | 4/1/2007 | C | IW CLOSED FINGER IN REFRIGERATOR |
| RIGHT INDEX FINGER FOREIGN BODY | Caught; in, under, between, | $230.29 | $230.29 | $230.29 | $0.00 | $0.00 | $230.29 | $230.29 | $0.00 | ||||||||||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 077050000070 | 11/27/2006 | C | IW was shot in head with nailgun | Cut; powered hand tool, appliance | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 077050000076 | 5/20/2007 | C | IW using meat slicer, slipped and cut finger. | Cut; powered hand tool, appliance | $2,099.60 | $2,099.60 | $2,099.60 | $0.00 | $0.00 | $0.00 | $2,099.60 | $2,099.60 | $0.00 | |||||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 077050000077 | 5/10/2007 | C | IW claims that he was lifting an access hatch, it fell back onto his head. -recurrent headaches/ neck pain?- | Strike; object being lifted or handled | $15,995.29 | $15,995.29 | $15,995.29 | $23,530.82 | $23,530.82 | $23,530.82 | $2,850.83 | $2,850.83 | $42,376.94 | $42,376.94 | $0.00 | |||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 077050000078 | 5/31/2007 | C | lifting 30 bags @ 94lbs each | Strain; lifting | $8,805.86 | $8,805.86 | $8,805.86 | $0.00 | $0.00 | $0.00 | $8,805.86 | $8,805.86 | $0.00 | |||||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 077050000089 | 4/24/2007 | C | The gardeners trimmed the trees and left them on the ground and I tripped on them |
and fell to the ground.
| -Low back strain- | Fall, slip or trip, | $0.00 | $0.00 | $0.00 | $6.25 | $6.25 | $6.25 | $6.25 | $0.00 | ||||||||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 077050000092 | 1/8/2007 | C | On 1/8/07, IW was cooking and preparing. Cooking oil evaporated on IW from cooking pan. | Burn; steam or hot fluids | $12,390.38 | $12,390.38 | $12,390.38 | $8,359.43 | $8,359.43 | $8,359.43 | $20,749.81 | $20,749.81 | $0.00 | |||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 077050000093 | 7/5/2007 | C | On 7/5/07, was cleaning fryer when hot oil spilled on IW. | |||||||||||||
| -left thigh and left shoulder burn | Burn; steam or hot fluids | $16,401.23 | $16,401.23 | $16,401.23 | $51,374.95 | $51,374.95 | $51,374.95 | $67,776.18 | $67,776.18 | $0.00 | |||||||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 077050000100 | 4/13/2007 | C | On 4/13/07, IW was replacing new upolstery for a customers car and right elbow suddenly popped. | |||||||||||||
| -right elbow strain- | Strain; pushing or pulling | $1,024.02 | $1,024.02 | $1,024.02 | $922.76 | $922.76 | $922.76 | $1,946.78 | $1,946.78 | $0.00 | |||||||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 077050000105 | 2/16/2006 | C | oN 2/16/06, IW cut hand while adjusting belt sander. | |||||||||||||
| -left hand laceration- | Cut; powered hand tool, appliance | $157.24 | $157.24 | $157.24 | $157.24 | $157.24 | $0.00 | ||||||||||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 077050000120 | 8/22/2007 | C | On 8/22/07, IW alleges truck fell off of jack and landed on him. | |||||||||||||
| -cervical spine strain, lumbar spine strain and left knee contusion.- | Injured by; moving parts of machine | $0.00 | $0.00 | $0.00 | $436.00 | $436.00 | $436.00 | $436.00 | $0.00 | ||||||||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 077050000139 | 8/10/2006 | C | On 8/15/06, after climbing out of the tree, employee jumped on IW's back knocking him down to the ground face first. | Injured by; Another Person | $3,509.60 | $3,509.60 | $3,509.60 | $3,509.60 | $3,509.60 | $0.00 | ||||||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 077050000144 | 8/17/2007 | C | On 8/17/07 IW fell 40 feet to concrete from tree. | |||||||||||||
| -CLAIM DENIED- | Fall; from different level/elevation | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||||||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 087050000006 | 11/6/2007 | C | On 11/6/07, IW was test driving motorcycle. Throttle broke on bike and IW lost control of motorcycle | |||||||||||||
| -left wrist fracture bilateral arm road rash- | Vehicle; motor vehicle | $10,345.01 | $10,345.01 | $10,345.01 | $22,223.05 | $22,223.05 | $22,223.05 | $32,568.06 | $32,568.06 | $0.00 | |||||||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 087050000034 | 9/19/2007 | C | On 9/19/07, was taking ashes out with shovel. |
| -right shoulder strain- | Strain; strain or injury by, | $126.72 | $126.72 | $126.72 | $126.72 | $126.72 | $0.00 | ||||||||||||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 087050000036 | 7/12/2007 | C | On 7/12/07, IW sustained left ear laceration when co-worker dropped air hose. | |||||||||||||||
| -left ear laceration- | Cut; object being lifted or handled | $122.91 | $122.91 | $122.91 | $122.91 | $122.91 | $0.00 | ||||||||||||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 087050000037 | 1/28/2007 | C | On 1/28/07, IW was working on a lamp/fountain display. A person was driving a golf cart and hit a waterfall display weighing approximately 400 lbs and it fell on the IW. -cervical and thoracic sprain/strain, rt elbow contusion, bilateral shoulder sprain | Injured by; falling or flying object | $6,855.46 | $6,855.46 | $6,855.46 | $20,346.19 | $20,346.19 | $20,346.19 | $6.85 | $6.85 | $27,208.50 | $27,208.50 | $0.00 | |||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 087050000041 | 11/12/2007 | C | On 11/12/07, caught foot on chair and fell to the ground. | |||||||||||||||
| -lumbar spine sprain- | Fall, slip or trip, | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||||||||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 087050000043 | 6/20/2007 | C | On 6/20/07, IW indicated that she fell when handing out flyers | |||||||||||||||
| -right wrist fracture- | Fall; on same level | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||||||||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 087050000048 | 6/20/2007 | C | On 6/20/07, guard on saw tied up. Got stuck in cord. IW tried to get cord unstuck when blade cut arm. | |||||||||||||||
| -left forearm laceration- | Cut; powered hand tool, appliance | $11,680.05 | $11,680.05 | $11,680.05 | $16,475.30 | $16,475.30 | $16,475.30 | $28,155.35 | $28,155.35 | $0.00 | |||||||||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 087050000053 | 3/3/2007 | C | On 3/3/07, assailant grabbed IW and pulled him to counter. He jumped counter and tried to stab the IW. | |||||||||||||||
| -right hand laceration- | Cut; hand tool, utensil, not powered | $4,572.14 | $4,572.14 | $4,572.14 | $0.00 | $0.00 | $0.00 | $4,572.14 | $4,572.14 | $0.00 | |||||||||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 087050000059 | 1/3/2008 | C | On 1/3/08, was involved in MVA. IW hit vehicle in front of him. | |||||||||||||||
| -cervical, thoracic, lumbar strain | Vehicle; collide with other vehicle | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||||||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 087050000066 | 9/14/2007 | C | On 9/14/07, was lifting slab of granite. |
| -lumbar spine strain- | Strain; lifting | $15,328.45 | $15,328.45 | $15,328.45 | $18,576.56 | $18,576.56 | $18,576.56 | $426.72 | $426.72 | $6.85 | $6.85 | $34,338.58 | $34,338.58 | $0.00 |
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 087050000082 | 1/25/2008 | C | On 1/25/08, Was walking up ladder carrying bucket of cement. Leveling floor, foot slipped on rung of ladder. Weight shifted bucket of concrete. Injured back. | ||||||||||
| -CLAIM DENIED- | Fall; from ladder or scaffolding | $0.00 | $0.00 | $0.00 | ||||||||||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 087050000085 | 11/26/2007 | C | On 11/26/07, IW indicated he injured both shoulders while lifting a cabinet. |
| -bilateral shoulder strain- | Strain; lifting | $276.72 | $276.72 | $276.72 | $52,356.68 | $52,356.68 | $52,356.68 | $6.50 | $6.50 | $52,639.90 | $52,639.90 | $0.00 | ||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 087050000086 | 11/19/2007 | C | While cutting wood flooring on the table saw wood caught and jumped and cut hand. | ||||||||||
| -left index finger laceration/fracture | Cut; powered hand tool, appliance | $3,386.67 | $3,386.67 | $3,386.67 | $4,578.31 | $4,578.31 | $4,578.31 | $7,964.98 | $7,964.98 | $0.00 | ||||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 087050000092 | 11/28/2007 | C | On 11/28/07 lifted refrigerator by myself per boss and it was to heavy and my back popped. | ||||||||||
| -lumbar spine strain- | Strain; lifting | $51,122.41 | $51,122.41 | $51,122.41 | $5,586.08 | $5,586.08 | $5,586.08 | $2,744.19 | $2,744.19 | $787.33 | $787.33 | $60,240.01 | $60,240.01 | $0.00 |
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 087050000099 | 11/24/2007 | C | On 11/24/07, IW slipped off from roof and fell 13 ft to the ground. | ||||||||||
| -left calcaneal fracture- | Fall; from different level/elevation | $45,110.98 | $45,110.98 | $45,110.98 | $13,862.34 | $13,862.34 | $13,862.34 | $6,536.68 | $6,536.68 | $49.35 | $49.35 | $65,559.35 | $65,559.35 | $0.00 |
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 087050000110 | 9/8/2007 | C | On 9/8/07 IW states he was climbing out of a hole when he injured his leg. | ||||||||||
| -Claim denied- | Climbing | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 087050000112 | 2/8/2008 | C | On 2/8/08, was pulling freight from off truck. Freight stuck together. Began pulling. Felt rip a rib in middle of back | ||||||||||
| -thoracic spine strain & right thigh strain- | Strain; lifting | $4,700.51 | $4,700.51 | $4,700.51 | $9,008.75 | $9,008.75 | $9,008.75 | $2,298.92 | $2,298.92 | $16,008.18 | $16,008.18 | $0.00 | ||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 087050000122 | 7/12/2007 | C | On 7/12/07, I was cutting blocks for the patio and the skill saw jumped and cut left hand. | ||||||||||
| -left hand laceration- | Cut; powered hand tool, appliance | $6,193.91 | $6,193.91 | $6,193.91 | $24,854.07 | $24,854.07 | $24,854.07 | $31,047.98 | $31,047.98 | $0.00 | ||||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 087050000127 | 4/6/2007 | C | On 4/6/07, hit head on tire machine. | ||||||||||
| -scalp laceration, closed head injury- | Strike; stationary object | $849.86 | $849.86 | $849.86 | $849.86 | $849.86 | $0.00 | |||||||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 087050000128 | 11/6/2007 | C | On 11/6/07, IW bumped his hand. | ||||||||||
| -right hand contusion/abrasion | Strike; against or stepping on | $177.97 | $177.97 | $177.97 | $177.97 | $177.97 | $0.00 | |||||||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 087050000169 | 7/20/2006 | C | On 7/20/06, IW slipped and fell on bathroom floor. |
| -Head contusion, cervical spine and lumbar spine strain- | Fall; on same level | $469.66 | $469.66 | $469.66 | $78.40 | $78.40 | $548.06 | $548.06 | $0.00 | ||||||||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 087050000282 | 5/7/2008 | C | On 5/7/08, was working (cashier). Smelled something bitter. Felt light headed. | |||||||||||||
| -one time inhalation exposure only- | Misc; other - miscellaneous, | $937.05 | $937.05 | $937.05 | $191.97 | $191.97 | $191.97 | $1,129.02 | $1,129.02 | $0.00 | |||||||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 087050000319 | 9/10/2007 | C | On 9/10/07, was loading power washer onto van. | |||||||||||||
| -lumbar strain- | Strain; lifting | $140.59 | $140.59 | $140.59 | $6.85 | $6.85 | $147.44 | $147.44 | $0.00 | ||||||||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 087050000468 | 10/23/2007 | C | On 10/23/07, was cutting some wood with table saw. Accidently cut left middle/index finger with saw. -left middle/index finger Fx/laceration- | Cut; powered hand tool, appliance | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 087050000506 | 12/2/2005 | C | On 12/2/05, was working on machine. Cut left thumb. | |||||||||||||
| -left thumb laceration- | Cut; object being lifted or handled | $2,142.64 | $2,142.64 | $2,142.64 | $0.00 | $0.00 | $0.00 | $2,142.64 | $2,142.64 | $0.00 | |||||||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 087050000539 | 5/16/2008 | C | On 5/16/08 , was loading truck with a stove. Difficulty positioning the stove. injured right knee. | |||||||||||||
| -right knee strain- | Strain; lifting | $7,041.74 | $7,041.74 | $7,041.74 | $14,153.09 | $14,153.09 | $14,153.09 | $6.85 | $6.85 | $21,201.68 | $21,201.68 | $0.00 | |||||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 087050000749 | 8/17/2008 | C | Misc; other - miscellaneous, | $3,097.65 | $3,097.65 | $3,097.65 | $3,397.26 | $3,397.26 | $3,397.26 | $6,494.91 | $6,494.91 | $0.00 | ||||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 087050000750 | 7/9/2008 | C | On 7/9/08, IW was moving a flower arrangement and vase broke in his hand | |||||||||||||
| -left thumb laceration/flexor tendon- | Cut; broken glass | $3,726.92 | $3,726.92 | $3,726.92 | $10,463.62 | $10,463.62 | $10,463.62 | $14,190.54 | $14,190.54 | $0.00 | |||||||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 087050000828 | 6/5/2008 | C | On 6/5/08, saw kicked back and struck hand. | |||||||||||||
| -left hand laceration- | Cut; powered hand tool, appliance | $1,117.03 | $1,117.03 | $1,117.03 | $1,117.03 | $1,117.03 | $0.00 | ||||||||||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 087050000891 | 3/27/2008 | C | On 3/27/08, IW fell down when she was sliding a box across the floor. |
| -cervical and lumbar spine strain- | Fall, slip or trip, | $4,382.55 | $4,382.55 | $4,382.55 | $17,121.60 | $17,121.60 | $17,121.60 | $21,504.15 | $21,504.15 | $0.00 |
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 087050001013 | 7/7/2008 | C | On 7/7/08, IW was lifting school room furniture. Strained abdomen-possible hernia. | ||||||
| -CLAIM DENIED- | Strain; lifting | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 087050001018 | 7/3/2008 | C | On 7/3/08, was lifting class room furniture. Strained abdomen-possible bilateral hernia |
| -CLAIM DENIED- | Strain; lifting | $0.00 | $0.00 | $0.00 | $757.61 | $757.61 | $757.61 | $757.61 | $0.00 | |||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 087050001201 | 8/18/2008 | C | On 8/18/08, was lifting boxes out of trunk. Hurt/pulled back. | ||||||||
| -lumbar spine strain- | Strain; lifting | $0.00 | $0.00 | $0.00 | $992.80 | $992.80 | $992.80 | $992.80 | $992.80 | $0.00 | ||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 087050001260 | 1/30/2008 | C | On 1/30/08-was fixing drawer. Cut left index finger on steel drawer. |
| -cut left index finger- | Cut; caught, punctured, scraped, | $198.00 | $198.00 | $198.00 | $198.00 | $198.00 | $0.00 | |
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 087050001263 | 9/24/2008 | C | On 9/24/08, IW was sweeping floor with broom. Supervisor took broom away. |
| -cervical, thoracic & lumbar spine sprain/strain- | Strain; pushing or pulling | $1,821.61 | $1,821.61 | $1,821.61 | $4,415.50 | $4,415.50 | $6,237.11 | $6,237.11 | $0.00 | |||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 087050001294 | 6/4/2008 | C | On 6/4/08, IW was cleaning attic. Ladder broke. IW fell from ladder to the ground. | ||||||||
| -bilateral knee sprain/strain- | Fall; from ladder or scaffolding | $2,150.66 | $2,150.66 | $2,150.66 | $1,037.19 | $1,037.19 | $1,037.19 | $3,187.85 | $3,187.85 | $0.00 | ||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 097050000049 | 4/10/2008 | C | Beer bottle was thrown 5 feet away. Hit above left eye. | ||||||||
| -left eye laceration- | Cut; broken glass | $588.94 | $588.94 | $588.94 | $588.94 | $588.94 | $0.00 | |||||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 097050000050 | 11/11/2008 | C | Pre-treating T-shirt. Rash on face and head. | ||||||||
| -CLAIM DENIED- | Burn; Chemicals | $197.84 | $197.84 | $197.84 | $197.84 | $197.84 | $0.00 | |||||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 097050000096 | 6/3/2008 | C | On 6/3/08, IW was installing toilet. When IW stood up, his left knee twisted and popped. | ||||||||
| -left knee strain- | Strain; lifting | $250.00 | $250.00 | $250.00 | $17,385.95 | $17,385.95 | $17,385.95 | $880.84 | $880.84 | $18,516.79 | $18,516.79 | $0.00 |
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 097050000133 | 6/22/2007 | C | Hit in left forearm with nail gun. |
| -puncture wound left forearm- | Injured by; hand tool or machine in use | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 097050000161 | 11/5/2008 | C | IW was lifting boxes off of pallet. |
Back/groin pain.
| -lumbar spine strain and right groin strain- | Strain; lifting | $13,578.41 | $13,578.41 | $13,578.41 | $34,982.99 | $34,982.99 | $34,982.99 | $5,394.92 | $5,394.92 | $53,956.32 | $53,956.32 | $0.00 |
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 097050000298 | 7/18/2008 | C | Cut fingers on lawn mower. |
| -amputation left index, middle and ring fingers- | Caught; machine or machinery | $3,622.43 | $3,622.43 | $3,622.43 | $39,409.61 | $39,409.61 | $39,409.61 | $43,032.04 | $43,032.04 | $0.00 | ||||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 097050000329 | 12/29/2008 | C | IW was registering his firearm when the gun went off. Bullet wound to left hand. | ||||||||||
| -CLAIM DENIED- | Misc; other - miscellaneous, | $0.00 | $0.00 | $0.00 | $33.00 | $33.00 | $33.00 | $33.00 | $0.00 | |||||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 097050000396 | 12/4/2006 | C | On 12/4/06, was putting flyers on door. Was walking across driveway to go to next house. Slipped on black ice. | ||||||||||
| -right ankle fracture- | Fall; on ice or snow | $6,799.64 | $6,799.64 | $6,799.64 | $2,101.10 | $2,101.10 | $2,101.10 | $6.85 | $6.85 | $8,907.59 | $8,907.59 | $0.00 | ||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 097050000552 | 2/16/2009 | C | On 2/16/09, shuttle bus driver slammed on breaks causing the IW to fall back and hit right ribs. | ||||||||||
| -right rib contusion. | Fall; on same level | $264.64 | $264.64 | $264.64 | $264.64 | $264.64 | $0.00 | |||||||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 097050000593 | 3/14/2009 | C | On 3/14/09, IW was cutting lemon grass thru machine. Cut right thumb | ||||||||||
| -right thumb laceration- | Cut; hand tool, utensil, not powered | $448.11 | $448.11 | $448.11 | $39.35 | $39.35 | $487.46 | $487.46 | $0.00 | |||||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 097050000659 | 2/8/2009 | C | On 2/8/09, IW was assaulted by co-worker. | ||||||||||
| -right eyelid laceration, left knee tibial plateau fracture and right knee sprain/strain contusion- | Injured by; Another Person | $18,895.40 | $18,895.40 | $18,895.40 | $27,743.17 | $27,743.17 | $27,743.17 | $13,271.14 | $13,271.14 | $6.85 | $6.85 | $59,916.56 | $59,916.56 | $0.00 |
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 097050000661 | 3/19/2008 | C | On 3/19/08, IW was on ladder and it fell from underneath him. IW fell down to the ground and landed on right ankle. | ||||||||||
| -right ankle sprain- | Fall; from ladder or scaffolding | $2,553.93 | $2,553.93 | $2,553.93 | $11,104.99 | $11,104.99 | $11,104.99 | $3,866.92 | $3,866.92 | $17,525.84 | $17,525.84 | $0.00 | ||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 097050000708 | 7/28/1994 | C | Ladder slipped off backwards and went to the floor with me holding onto ladder. |
| -right wrist/elbow, chin laceration- | Fall; from ladder or scaffolding | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 097050000740 | 3/25/2009 | C | On 3/25/09, IW was carrying drywall upstairs when he tripped and the drywall fell on his rt hand injuring rt middle finger. | ||||||||||
| -right middle finger fracture/laceration- | Cut; object being lifted or handled | $1,613.57 | $1,613.57 | $1,613.57 | $1,540.10 | $1,540.10 | $1,540.10 | $6.85 | $6.85 | $3,160.52 | $3,160.52 | $0.00 | ||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 097050000953 | 12/21/2008 | C | Working on patio. Plywood shifted and fell on the IW. IW fell off of ladder and landed on ground. | ||||||||||
| -cervical and lumbar spine strain- | Fall; from ladder or scaffolding | $4,916.56 | $4,916.56 | $4,916.56 | $15,911.10 | $15,911.10 | $15,911.10 | $4,849.85 | $4,849.85 | $25,677.51 | $25,677.51 | $0.00 | ||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 097050001050 | 3/4/2009 | C | On 3/4/09, IW was fixing water filter. Left foot slipped off pipe and IW twisted back. | ||||||||||
| -lumbar spine strain- | Slipped: did not fall | $8,332.96 | $8,332.96 | $8,332.96 | $1,392.36 | $1,392.36 | $1,392.36 | $25.55 | $25.55 | $9,750.87 | $9,750.87 | $0.00 | ||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 097050001083 | 7/2/2009 | C | On 7/2/09, IW was drilling hole in steel plate cover. The cover spun around and cut left hand. | ||||||||||
| -left hand laceration- | Cut; object being lifted or handled | $247.12 | $247.12 | $247.12 | $476.20 | $476.20 | $476.20 | $7.20 | $7.20 | $730.52 | $730.52 | $0.00 | ||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 097050001094 | 3/1/2009 | C | On 3/1/09, was pulling sheets off of bed. Turned and felt something snap in back | ||||||||||
| -lumbar spine strain- | Strain; pushing or pulling | $16,783.27 | $16,783.27 | $16,783.27 | $11,966.06 | $11,966.06 | $11,966.06 | $5,220.36 | $5,220.36 | $287.26 | $287.26 | $34,256.95 | $34,256.95 | $0.00 |
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 097050001095 | 7/10/2009 | C | On 7/11/09, IW fell off ladder injuring his right knee and lumbar spine. | ||||||||||
| -right knee and lumbar spine strain- | Fall; from ladder or scaffolding | $15,621.52 | $15,621.52 | $15,621.52 | $15,322.77 | $15,322.77 | $15,322.77 | $5,150.68 | $5,150.68 | $1,908.93 | $1,908.93 | $38,003.90 | $38,003.90 | $0.00 |
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 097050001147 | 6/27/2009 | C | On 6/27/09, IW was working on pool. Climbed ladder. The ladder fell to the side. IW landed on the ground. Twisted ankle. | ||||||||||
| -right ankle calcaneal fracture- | Fall; from ladder or scaffolding | $9,804.82 | $9,804.82 | $9,804.82 | $17,623.82 | $17,623.82 | $17,623.82 | $17,235.83 | $17,235.83 | $1,282.60 | $1,282.60 | $45,947.07 | $45,947.07 | $0.00 |
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 097050001163 | 1/6/2009 | C | On 1/6/09, was climbing up extension ladder with drill in hand. Ladder slid down the wall pinning arm between the ladder and the ground. | ||||||||||
| -left wrist fracture- | Strike; moving parts of machine | $30,741.00 | $30,741.00 | $30,741.00 | $68,758.00 | $68,758.00 | $68,758.00 | $12,892.70 | $12,892.70 | $2,931.54 | $2,931.54 | $115,323.24 | $115,323.24 | $0.00 |
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 097050001216 | 9/10/2009 | C | On 9/10/09, IW was lifting frozen food to the freezer. | ||||||||||
| -left shoulder sprain/strain- | Strain; lifting | $19,044.75 | $19,044.75 | $19,044.75 | $6,000.99 | $6,000.99 | $6,000.99 | $0.00 | $0.00 | $14.16 | $14.16 | $25,059.90 | $25,059.90 | $0.00 |
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 097050001222 | 8/7/2009 | C | On 8/7/09, IW got into a confrontation with owner. IW alleges owner choked him. | ||||||||||
| -cervical and lumbar spine strain- | Injured by; Another Person | $813.82 | $813.82 | $813.82 | $0.00 | $0.00 | $813.82 | $813.82 | $0.00 | |||||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 097050001294 | 9/4/2009 | C | On 9/4/09, IW was involved in MVA. |
| -cervical, thoracic, lumbar spine sprain/strain and facial abrasion- | Vehicle; collision with fixed object | $1,164.92 | $1,164.92 | $1,164.92 | $3,468.64 | $3,468.64 | $3,468.64 | $168.00 | $168.00 | $4,801.56 | $4,801.56 | $0.00 |
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 097050001310 | 8/31/2009 | C | On 8/31/09, IW was bending down to pick up something when his foot slipped and he twisted his right knee. | ||||||||
| -right knee sprain/strain | Slipped: did not fall | $1,780.44 | $1,780.44 | $1,780.44 | $3,207.78 | $3,207.78 | $3,207.78 | $0.00 | $0.00 | $4,988.22 | $4,988.22 | $0.00 |
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 097050001344 | 1/17/2009 | C | On 1/17/09, IW lost his footing while on roof and fell to the first floor. | ||||||||
| -left leg/foot fracture- | Fall, slip or trip, | $17,603.78 | $17,603.78 | $17,603.78 | $10,236.56 | $10,236.56 | $10,236.56 | $10.25 | $10.25 | $27,850.59 | $27,850.59 | $0.00 |
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 097050001357 | 2/16/2007 | C | On 2/16/07, IW was lifting packages when he strained his right wrist. | ||||||||
| -right wrist strain- | Strain; lifting | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $352.85 | $352.85 | $352.85 | $352.85 | $0.00 |
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 097050001390 | 6/30/2009 | C | On 6/30/09, IW was involved MVA. |
| -DENIED- | Vehicle; collide with other vehicle | $0.00 | $0.00 | $0.00 | $1,339.25 | $1,339.25 | $1,339.25 | $1,339.25 | $0.00 | |
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 097050001403 | 2/5/2009 | C | On 2/5/09,. IW tripped over cord cover. Twisted left foot. |
| -left foot strain- | Strain; twisting | $20,261.96 | $20,261.96 | $20,261.96 | $21,127.55 | $21,127.55 | $21,127.55 | $2,826.98 | $2,826.98 | $44,216.49 | $44,216.49 | $0.00 |
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 107050000041 | 10/13/2009 | C | On 10/13/09, was trimming bushes when he cut right index finger on trimmer. |
| -right index finger laceration- | Cut; powered hand tool, appliance | $577.97 | $577.97 | $577.97 | $7.60 | $7.60 | $585.57 | $585.57 | $0.00 | ||||||||||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 107050000043 | 10/5/2009 | C | IW was involved in MVA on 10/5/09. IW was rearended by another vehicle while sitting at stop light. -cervical and lumbar spine spasm/strain | Vehicle; collide with other vehicle | $9,576.36 | $9,576.36 | $9,576.36 | $6,274.81 | $6,274.81 | $6,274.81 | $7.60 | $7.60 | $15,858.77 | $15,858.77 | $0.00 | |||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 107050000047 | 2/3/2009 | C | On 2/5/2010, IW was cleaning dirt from 6ft hole and the dirt caved in on him. | |||||||||||||||
| -right wrist fracture- | Caught; in, under, between, | $0.00 | $0.00 | $0.00 | $7.25 | $7.25 | $7.25 | $7.25 | $0.00 | ||||||||||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 107050000088 | 9/28/2009 | C | IW was on roof when he slipped. IW did not fall off the roof. | |||||||||||||||
| -DENIED- | Slipped: did not fall | $0.00 | $0.00 | $0.00 | $7.25 | $7.25 | $7.25 | $7.25 | $0.00 | ||||||||||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 107050000131 | 11/13/2009 | C | On 11/13/09, IW was coming down ladder. Ladder collapsed. IW fell to the ground. | |||||||||||||||
| -right leg lateral tibial plateau fracture- | Fall; from ladder or scaffolding | $19,778.26 | $19,778.26 | $19,778.26 | $35,200.54 | $35,200.54 | $35,200.54 | $12,021.38 | $12,021.38 | $7.25 | $7.25 | $67,007.43 | $67,007.43 | $0.00 | |||||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 107050000132 | 12/20/2006 | C | Cleaning some wood pieces to make them into stakes when one of the nails that IW pulled from the wood landed in right eye. | |||||||||||||||
| -right eye global rupture- | Misc; foreign matter (body) in eye(s) | $650.99 | $650.99 | $650.99 | $5,559.86 | $5,559.86 | $5,559.86 | $111.25 | $111.25 | $6,322.10 | $6,322.10 | $0.00 | |||||||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 107050000133 | 12/26/2009 | C | On 12/26/09, IW states that she slipped and fell on wet floor. | |||||||||||||||
| -CLAIM DENIED- | Fall, slip or trip, | $0.00 | $0.00 | $0.00 | $7.25 | $7.25 | $7.25 | $7.25 | $0.00 | ||||||||||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 107050000151 | 10/13/2009 | C | Accidentally broke glass. |
| -right hand laceration- | Cut; broken glass | $0.00 | $0.00 | $0.00 | $7.25 | $7.25 | $7.25 | $7.25 | $0.00 | |
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 107050000187 | 3/15/2008 | C | On 3/15/08, IW fell off of roof |
| -cervical strain, head contusion, left shoulder strain- | Fall; from different level/elevation | $6,966.22 | $6,966.22 | $6,966.22 | $7,902.70 | $7,902.70 | $7,902.70 | $7.25 | $7.25 | $14,876.17 | $14,876.17 | $0.00 |
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 107050000201 | 9/30/2008 | C | On 9/30/08, IW was working on a truck. IW put right leg in truck on brake. Truck started to move forward. Door closed on right leg. IW hit head on lift. | ||||||||
| -Closed head injury, left forehead contusion and right thigh contusion- | Caught; in, under, between, | $440.64 | $440.64 | $440.64 | $440.64 | $440.64 | $0.00 | |||||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 107050000278 | 12/1/2009 | C | IW states that on 12/1/09, he was reaching for a computer underneath table. IW hit his back on table. | ||||||||
| -CLAIM DENIED- | Strike; stationary object | $0.00 | $0.00 | $0.00 | $7.25 | $7.25 | $7.25 | $7.25 | $0.00 | |||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 107050000293 | 1/9/2010 | C | On 1/9/10 IW was involved in an altercation with the employer after he was terminated from employment. | ||||||||
| -DENIED- | Injured by; Another Person | $0.00 | $0.00 | $0.00 | $54.25 | $54.25 | $54.25 | $54.25 | $0.00 | |||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 107050000320 | 10/1/2009 | C | On 10/1/09, IW was painting on top of roof when he slid on a piece of plastic and fell. | ||||||||
| -occipital skull fracture- | Fall; from different level/elevation | $5,092.59 | $5,092.59 | $5,092.59 | $20.15 | $20.15 | $5,112.74 | $5,112.74 | $0.00 | |||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 107050000365 | 7/25/2009 | C | On 7/25/09, catering truck that IW was working in was struck by another vehicle. |
-lumbar spine strain & left shoulder strain-
| DO NOT REOPEN 0 OFFSET $9,286.23 | Injured by; motor vehicle | $1,360.04 | $1,360.04 | $1,360.04 | $105.25 | $105.25 | $1,465.29 | $1,465.29 | $0.00 | |||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 107050000366 | 7/25/2009 | C | On 7/25/09, catering truck that IW was working in was struck by another vehicle. lumbar spine strain/contusion- | ||||||||
| DO NOT REOPEN - OFFSET $5,589.52 | Injured by; motor vehicle | $1,770.60 | $1,770.60 | $1,770.60 | $119.05 | $119.05 | $119.05 | $80.25 | $80.25 | $1,969.90 | $1,969.90 | $0.00 |
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 107050000443 | 3/13/2010 | C | IW was stabbed by assailant during robbery. |
| -PTSD, left thigh and left 3rd finger laceration- | Injured by; struck or injured | $11,248.74 | $11,248.74 | $11,248.74 | $7,552.28 | $7,552.28 | $7,552.28 | $5,799.78 | $5,799.78 | $24,600.80 | $24,600.80 | $0.00 | |||||||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 107050000470 | 11/21/2009 | C | On 11/21/09, IW tripped on raised concrete walkway and fell to the ground. | |||||||||||||||
| -right elbow radial head fracture, right wrist sprain, left ankle sprain and cervical spine strain- | Fall, slip or trip, | $2,196.41 | $2,196.41 | $2,196.41 | $1,913.57 | $1,913.57 | $1,913.57 | $7.25 | $7.25 | $4,117.23 | $4,117.23 | $0.00 | |||||||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 107050000531 | 10/23/2009 | C | IW alleges she slipped on a rug in kitchen and hurt her low back. -cervical, thoracic and lumbar spine strain- | Fall, slip or trip, | $11,963.64 | $11,963.64 | $11,963.64 | $20,416.44 | $20,416.44 | $20,416.44 | $400.00 | $400.00 | $2,679.53 | $2,679.53 | $35,459.61 | $35,459.61 | $0.00 | |
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 107050000638 | 5/3/2010 | C | On 5/3/10, IW was lifting boxes onto top shelf when he felt a pop in his right shoulder. | |||||||||||||||
| -right shoulder sprain- | Strain; lifting | $4,505.99 | $4,505.99 | $4,505.99 | $18,569.30 | $18,569.30 | $18,569.30 | $7.25 | $7.25 | $23,082.54 | $23,082.54 | $0.00 | |||||||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 107050000884 | 12/15/2009 | C | On 12/15/09, IW was loading a king sized mattress onto truck when he fell off the truck and injured his right wrist. | |||||||||||||||
| -right wrist distal radius fracture- | Fall, slip or trip, | $19,639.86 | $19,639.86 | $19,639.86 | $32,930.40 | $32,930.40 | $32,930.40 | $876.28 | $876.28 | $10.25 | $10.25 | $53,456.79 | $53,456.79 | $0.00 | |||||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 107050000890 | 7/23/2010 | C | On 7/23/10, IW was involved in MVA. IW rear ended vehicle that was parked in the middle of the street. | |||||||||||||||
| -left hand fracture 2nd & 3rd metacarpal- | Vehicle; collide with other vehicle | $2,167.93 | $2,167.93 | $2,167.93 | $2,144.15 | $2,144.15 | $2,144.15 | $212.25 | $212.25 | $4,524.33 | $4,524.33 | $0.00 | |||||||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 107050001029 | 6/9/2010 | C | On 6/9/10, IW was landing parachute (skydive instructor). Parachute and IW were picked up and slammed back into the ground by a dust devil. | |||||||||||||||
| -CLAIM DENIED-MEDICAL INVESTIGATION- | Strike; against or stepping on | $0.00 | $0.00 | $0.00 | $7.25 | $7.25 | $7.25 | $7.25 | $0.00 | ||||||||||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 107050001085 | 7/12/2010 | C | On 7/12/10, IW was lifting 800 lb printer on to dolly when the printer slipped and he strained his low back. | |||||||||||||||
| -lumbar spine strain- | Strain; lifting | $371.64 | $371.64 | $371.64 | $7.25 | $7.25 | $378.89 | $378.89 | $0.00 | ||||||||||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 107050001086 | 8/7/2010 | C | IW was involved in MVA. |
| -cervical, thoracic & lumbar strain- | Vehicle; collide with other vehicle | $7,071.76 | $7,071.76 | $7,071.76 | $7,071.76 | $7,071.76 | $0.00 | |
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 107050001113 | 8/12/2010 | C | On 8/12/10, IW hit finger on drill. Drill bit imbeded in right index finger. |
| -foreign body right index finger- | Injured by; hand tool or machine in use | $509.89 | $509.89 | $509.89 | $0.00 | $0.00 | $509.89 | $509.89 | $0.00 | ||||||||||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 107050001114 | 7/30/2010 | C | On 7/30/10, IW was putting metal pole into the ground. IW was struck in the head by pole when the pole shifted. | |||||||||||||||
| -head contusion/concussion- | Injured by; struck or injured | $1,804.53 | $1,804.53 | $1,804.53 | $10.25 | $10.25 | $1,814.78 | $1,814.78 | $0.00 | ||||||||||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 107050001115 | 8/19/2010 | C | On 8/19/10, IW slipped while carry aluminum rod. Dislocated right shoulder -right shoulder strain- | Slipped: did not fall | $12,512.68 | $12,512.68 | $12,512.68 | $57,240.88 | $57,240.88 | $57,240.88 | $400.00 | $400.00 | $2,548.80 | $2,548.80 | $72,702.36 | $72,702.36 | $0.00 | |
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 107050001119 | 7/14/2010 | C | On 7/14/10, IW stated that clip board on dash fell into steering wheel causing him to lose control of vehicle. IW hit a power pole. | |||||||||||||||
| -CLAIM DENIED- | Vehicle; collision with fixed object | $0.00 | $0.00 | $0.00 | $7.25 | $7.25 | $7.25 | $7.25 | $0.00 | ||||||||||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 107050001151 | 7/7/2010 | C | IW states that she developed hearing loss over a two month period while using earphones while transcribing. | |||||||||||||||
| -noise trauma- | Unknown | $2,613.41 | $2,613.41 | $2,613.41 | $7.25 | $7.25 | $2,620.66 | $2,620.66 | $0.00 | ||||||||||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 107050001166 | 9/1/2010 | C | On 9/1/10, IW alleges that she hit her left knee on desk and also injured her lumbar spine when moving quickly in her chair. | |||||||||||||||
| -CLAIM DENIED- | Strike; against or stepping on | $1,249.91 | $1,249.91 | $1,249.91 | $7.55 | $7.55 | $1,257.46 | $1,257.46 | $0.00 | ||||||||||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 107050001186 | 9/16/2010 | C | On 9/16/10, IW slipped on wet floor and fell to the ground. IW hit her head on the floor. | |||||||||||||||
| -head contusion and cervical spine contusion- | Fall, slip or trip, | $1,158.01 | $1,158.01 | $1,158.01 | $35.60 | $35.60 | $1,193.61 | $1,193.61 | $0.00 | ||||||||||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 107050001219 | 5/31/2010 | C | IW alleges that he reinjured his right foot on 5/31/10 when he was trying to move 3500 lb machine with a pry bar. IW alleges that he was exposed to chemicals. | |||||||||||||||
| -CLAIM DENIED- | Strike; object being lifted or handled | $0.00 | $0.00 | $0.00 | $57.02 | $57.02 | $57.02 | $57.02 | $0.00 | ||||||||||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 107050001240 | 8/22/2010 | C | IW states that on 8/22/10, was getting out of truck and slipped on step that had anti-freeze on it. | |||||||||||||||
| -cervical, thoracic & lumbar strain- | Slipped: did not fall | $12,920.13 | $12,920.13 | $12,920.13 | $47,629.61 | $47,629.61 | $47,629.61 | $2,389.00 | $2,389.00 | $2,946.25 | $2,946.25 | $65,884.99 | $65,884.99 | $0.00 | |||||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 107050001241 | 8/30/2010 | C | IW states that he bumped his left knee against a desk/table. Left knee sprain. Denied course & scope-discrepancies in description of injury. | |||||||||||||||
| -CLAIM DENIED- | Strike; stationary object | $0.00 | $0.00 | $0.00 | $7.55 | $7.55 | $7.55 | $7.55 | $0.00 | ||||||||||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 117050000008 | 10/18/2010 | C | On 10/18/10, IW was cutting parsley with knife when he cut his left middle finger. | |||||||||||||||
| -left middle finger laceration- | Cut; hand tool, utensil, not powered | $315.94 | $315.94 | $315.94 | $315.94 | $315.94 | $0.00 | ||||||||||||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 117050000028 | 2/9/2010 | C | On 2/9/10, IW was walking down ladder when his left knee gave out. | |||||||||||||||
| -left knee strain- | Climbing | $312.13 | $312.13 | $312.13 | $0.00 | $0.00 | $312.13 | $312.13 | $0.00 | ||||||||||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 117050000051 | 11/8/2010 | C | IW states that on 11/8/10, she got out of the work truck and stepped down two steps. When she stepped down onto the ground, her left knee buckled. -left knee strain- | Unknown | $5,441.07 | $5,441.07 | $5,441.07 | $2,518.35 | $2,518.35 | $7,959.42 | $7,959.42 | $0.00 | ||||||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 117050000129 | 9/8/2010 | C | On 9/8/10, IW states that plank he was standing on had a twist in it and he fell to the ground. | |||||||||||||||
| -CLAIM DENIED- | Fall; from ladder or scaffolding | $0.00 | $0.00 | $0.00 | $2.85 | $2.85 | $2.85 | $2.85 | $0.00 | ||||||||||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 117050000133 | 6/15/2010 | C | On 6/15/10, IW was loading a curbing machine onto truck with co-worker when the machine slipped and crushed right thumb. | |||||||||||||||
| -right thumb laceration- | Cut; object being lifted or handled | $473.46 | $473.46 | $473.46 | $0.00 | $0.00 | $473.46 | $473.46 | $0.00 | ||||||||||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 117050000141 | 10/23/2010 | C | Strain; lifting | $4,497.05 | $4,497.05 | $4,497.05 | $3,523.41 | $3,523.41 | $3,523.41 | $0.00 | $0.00 | $8,020.46 | $8,020.46 | $0.00 | ||||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 117050000165 | 12/17/2010 | C | On 12/17/10, IW was filling water dish in the condor breeding cage and the male condor flew down and bit IW's bottom lip. | |||||||||||||||
| -lip laceration- | Injured by; animal or insect | $329.26 | $329.26 | $329.26 | $0.00 | $0.00 | $329.26 | $329.26 | $0.00 | ||||||||||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 117050000180 | 12/6/2010 | C | On 12/6/10, IW was using rooter table saw and cut his right hand. |
| -right hand laceration- | Cut; hand tool, utensil, not powered | $315.58 | $315.58 | $315.58 | $0.00 | $0.00 | $315.58 | $315.58 | $0.00 | ||||||||||
| DIR WCS UNINSURED EMPLOYERS CLAIMS ACCOUNT | 117050000188 | 3/14/2010 | C | On 3/14/10, IW was hit in the neck with a bottle. | |||||||||||||||
| -neck laceration- | Cut; broken glass | $13,382.71 | $13,382.71 | $13,382.71 | $11,088.08 | $11,088.08 | $11,088.08 | $7.90 | $7.90 | $24,478.69 | $24,478.69 | $0.00 |
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